Predictive Factors of Social Functioning in Patients with Schizophrenia: Exploration for the Best Combination of Variables Using Data Mining

Objective

This study aimed to use data mining to explore the significantly contributing variables to good social functioning in schizophrenia patients.

Methods

The study cohort comprised 67 schizophrenia patients on stable medication. A total of 51 variables (6 demographic data, 3 illness history, 22 social cognition, 16 neurocognition, 4 psychiatric symptoms) were input into a data-mining decision tree using the Answer Tree program to find the pathway for the best social functioning.

Results

Several contributing factors for good social functioning were found. Continuous attention was the strongest contributing factor. Three variables involving best social functioning included good continuous attention, good theory of mind (TOM), and low sensitivity of disgust emotion.

Conclusion

Our results confirmed the mediating roles of social cognition between neurocognition and functional outcomes, and suggested that social cognition can significantly predict social functioning in schizophrenia patients.     

精神分裂症患者的心理社会干预

精神分裂症的治疗不仅包括药物治疗,还包括为患者提供支持、有效的信息、心理社会干预以及康复治疗。中国的研究者在精神分裂症患者非药物治疗领域进行着各项研究,而国外研究数据一致显示心理社会干预可以降低复发率和再住院率。尽管缓解症状仍然是精神分裂症治疗的一个重要目标,但工作、学习,独：立生活及社会化方面的功能损伤往往也是患者及其家属关注的重点。因此,精神分裂症患者更有可能从着重于减轻残疾的干预中获益。本文对中外有效应用于精神分裂症患者的主要心理社会干预进行综述,包括认知行为治疗、社会技能训练、家庭干预、认知纠正、心理教育、职业训练、危机干预及综合心理治疗;同时就中外心理社会干预的差异进行讨论     

Factors Affecting the Management of Somatic Comorbidity in Tunisian Patients with Schizophrenia

Psychiatric Quarterly - Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the...     

Effective Interaction With Patients With Schizophrenia: Qualitative Evaluation of the Interaction Skills Training Programme

PURPOSE.  The purpose of this study was to describe experiences of caregivers with the Interaction Skills Training Programme, and to evaluate the training effects observed by caregivers.
DESIGN AND METHODS.  A qualitative research design was applied. Semistructured interviews were conducted with 17 caregivers who had followed the training program.
FINDINGS.  The research findings clearly confirm the value of the program. Positive effects of the training were reported in terms of: (a) awareness and insightfulness; (b) the attitude of caregivers; (c) the quality of the therapeutic alliance; and (d) job perception.
PRACTICE IMPLICATIONS.  Training interactive skills may contribute to a better quality of care for chronic psychiatric patients. Based on the qualitative study, implementation of the skills training program can be recommended.     

中国脑出血医疗现状及死亡相关因素分析

【摘要】
目的 系统研究中国脑出血患者3个月、1年死亡的相关因素。
方法 本研究收集自2007年9月～2008年8月中国国家卒中登记数据库连续登记的来自全国27个省、4个直辖市及香港的132家医院的5136例发病14 d以内脑出血住院患者的人口学信息、临床资料、住院期间治疗及临床结局进行系统分析。采用Cox回归分析3个月、1年死亡的相关因素。
结果 脑出血3个月及1年的病死率分别为20.0%和26.1%。院内降压治疗是降低3个月［危险比（hazard ratio，HR）0.79，95%可信区间（confidence interval，CI）0.66～0.95］及1年（HR 0.84，95%CI 0.72～0.98）死亡的相关因素。年龄［3个月（66～75岁：HR 1.54，95%CI 1.08～2.20；≥76岁：HR 2.13，95%CI 1.49～3.04）；1年（66～75岁：HR 1.62，95%CI 1.19～2.21；≥76岁：HR 2.43，95%CI 1.78～3.31）］，入院格拉斯哥昏迷量表评分［3个月（9～12分：HR 2.36，95%CI 1.66～3.36；3～8分：HR 5.11，95%CI 3.67～7.11）；1年（9～12分：HR 2.23，95%CI 1.67～2.97；3～8分：HR 4.41，95%CI 3.36～5.77）］，入院美国国立卫生研究院卒中量表评分≥15（3个月：HR 1.74，95%CI 1.28～2.38；1年：HR 1.70，95%CI 1.31～2.22），血糖（3个月：HR 1.06，95%CI 1.01～1.10；1年：HR 1.05，95%CI 1.02～1.09），血肿体积［3个月（幕上30～60 ml：HR 1.57，95%CI 1.22～2.02；幕上＞60 ml：HR 2.42，95%CI 1.86～3.14；幕下≤10 ml：HR 2.07，95%CI 1.51～2.85；幕下10～20 ml：HR 2.70，95%CI 1.64～4.45；幕下＞20 ml：HR 2.40，95%CI 1.41～4.09；1年（幕上30～60 ml：HR 1.55，95%CI 1.24～1.93；幕上＞60 ml：HR 2.48，95%CI 1.96～3.14；幕下≤10 ml：HR 1.86，95%CI 1.41～2.46；幕下10～20 ml：HR 2.38，95%CI 1.53～3.72；幕下＞20 ml：HR 2.42，95%CI 1.49～3.92）］，血肿破入脑室（3个月：HR 1.65，95%CI 1.37～1.99；1年：HR 1.47，95%CI 1.25～1.73），监护室治疗（3个月：HR 1.53，95%CI 1.25～1.87；1年：HR 1.56，95%CI 1.30～1.86），再发卒中（3个月：HR 2.71，95%CI 1.99～3.70；1年：HR 2.62，95%CI 1.98～3.47）及癫痫发作（3个月：HR 1.57，95%CI 1.05～2.35；1年：HR 1.57，95%CI 1.10～2.26）是3个月和1年死亡危险因素。静脉应用脱水药物治疗是3个月（HR 1.86，95%CI 1.04～3.31）死亡危险因素。
结论 加强脑出血患者住院期间的降压治疗，控制血糖，早期诊断并处理癫痫发作及再发卒中，参照脑出血治疗指南规范应用脱水药物，并对其他影响预后的危险因素及时发现及适当干预有望改善中国脑出血患者的长期预后。     

Help-seeking Behaviors of Chinese Patients with Schizophrenia Admitted to a Psychiatric Hospital

Purpose To investigate the help-seeking behaviors and related factors of Chinese psychiatric inpatients with schizophrenia. Method Two hundred and two patients with schizophrenia (ICD-10) were enrolled in this study. A locally-developed, semi-structured questionnaire was used to collect data, including data on illness and help-seeking histories from patients, informants, and medical records. Results Among 202 inpatients, 120 patients (59.4%) had sought help from at least one type of non-psychiatric facility (NPF), and 82 patients (40.6%) went to a psychiatric hospital directly. Among the NPFs they contacted, 66 patients (32.7%) tried traditional Chinese medicine (TCM) from licensed practitioners (including acupuncturists), 64 (31.7%) chose general hospitals (including 9 who went to emergency departments), and 52 (25.7%) sought help from qigong (breathing exercise) masters or other folk healing methods. The reasons for seeking treatment from NPFs varied; the most common ones included feeling shameful or stigmatized about going to psychiatric hospitals, inaccessibility to or unavailability of psychiatric hospitals, and fear of being incarcerated or receiving electric shock treatment. Conclusion A substantial proportion of psychiatric inpatients in China seek help from non-psychiatric facilities and/or folk healing methods. Feeling shameful or stigmatized, inaccessibility to and/or unavailability of psychiatric services are among the most common barriers to seeking psychiatric treatment. Patients who sought psychiatric help directly are likely to be female, with a chronic onset of illness, a mixed syndrome of positive and negative symptoms, or a better economic status. Submitted to: Administration and Policy in Mental Health and Mental Health Services Research.     

Therapeutic Horseback Riding for ACT Patients with Schizophrenia

One form of psychiatric leisure rehabilitation which has only recently been explored for individuals with schizophrenia is Therapeutic Horseback Riding (THBR). This study is the first to examine THBR for Assertive Community Treatment (ACT) patients with schizophrenia. A sample of 6 ACT patients with schizophrenia or schizoaffective disorder who reside in the community and 6 mental health care staff participated in 10 weeks of weekly horseback riding sessions with an experienced THBR instructor. Participating patients, staff and the THBR instructor were qualitatively interviewed at the start, during and at the end of the THBR program and these semi-structured interviews were analyzed for recurrent themes. We found that THBR benefitted this group of patients. In spite of our study’s limitations, such as its exploratory nature and the small sample size, it demonstrates that THBR has promise and should be further developed and studied for individuals with schizophrenia.     

Correction to: Assessment of Psychosocial Functioning in a Large Cohort of Patients with Schizophrenia

Psychiatric Quarterly -     

Satisfaction with Clinical Case Management Services of Patients with Long-Term Psychoses

Outpatients with long-term psychotic disorders from two clinical case management programs were interviewed one-on-one to determine their satisfaction with specific aspects of such services. Patients answered standardized questionnaires and two open-ended satisfaction questions. The close follow-up provided by these programs led us to expect high patient satisfaction, and most patients were very satisfied with their clinical case managers. Lower functioning patients, followed by more intensive clinical case management, were equally satisfied to those followed by a less intensive program. However, many patients revealed dissatisfaction with explanations about clinical treatment and services.     

One-Year Follow-Up of Serum Prolactin Level in Schizophrenia Patients Treated with Blonanserin: A Case Series

In our previous study, a prolactin elevation was more frequently in risperidone than in blonanserin; however, it was more often in blonanserin than in olanzapine. Therefore, while a rate of PRL rising is low to moderate, hyperprolactinemia is a considerable adverse effect in the blonanserin treatment. In this study, to examine detailed characteristics of hyperprolactinemia of blonanserin, we analyzed the prolactin data in six schizophrenic patients who were switched to blonanserin from other antipsychotics and followed for one year. As a result, blonanserin dose was clearly associated with serum prolactin level. The average prolactin level was almost normal when the mean blonanserin dosage was 8.0 mg/day. Regardless of the dose decrease of blonanserin, there were no remarkable changes in symptoms and social functions. Based on our findings, we conclude that low dose blonanserin medication may be useful for schizophrenia maintenance treatment without hyperprolactinemia and a high rate of relapse.     

Use of Advance Information in Patients with Schizophrenia

To document possible motor disturbance in schizophrenia, we examined the ability to use advance information (or cues) to plan movements in a sequential button pressing task in 12 Clozapine medicated patients. Programming of movements under various cues revealed that patients with schizophrenia, relative to controls, initiated movements slower to the right than left, providing possible evidence for right hemineglect (left hemisphere dysfunction). Additionally, patients with schizophrenia had difficulty in the initiation of movements in the absence of a cue, suggesting internal cue generation difficulty for movement related to some form of fronto-striatal disturbance. Motor abnormalities were predominantly observed at the level of movement initiation, but not execution, contrary to basal ganglia disorders such as Parkinson's and Huntington's disease.     

Assessment of Psychosocial Functioning in a Large Cohort of Patients with Schizophrenia

Background

This study addresses the question of whether psychosocial functioning measured by the Personal and Social Performance (PSP) Scale is related to various psychopathological measures in a cohort of patients with schizophrenia.

Methods

The ‘Neuroleptic Strategy Study’ (NeSSy) performed at 14 German hospitals between 2010 and 2013 compared two treatment strategies instead of individual drugs. Secondary end-points were the two PSP scales as well as measures of quality of life (SF-36) and the Positive and Negative Syndrome Scale (PANSS).

Results

149 patients were randomised. There was no difference between the two treatment strategies (first-generation versus second-generation antipsychotics) with regard to the PSP. There were differences in doctors’ assessments regarding psychosocial functioning compared with patients’ own assessments. Furthermore, there were relationships between the PSP and quality of life, level of skills (ICF), and severity of disease (PANSS), level of sexual activities and poor well-being under antipsychotic medication but not with cognitive changes.

Conclusions

The findings on psychosocial functioning of patients with schizophrenia related to severity and skill level could be confirmed. Further findings were the correlation between psychosocial functioning and quality of life, well-being under treatment, and sexuality what emphasizes the substantial importance of a reduced psychosocial functioning.

     

Rehabilitation Needs and Treatment of Patients with Schizophrenia

This study examines the key mental health policy agendas of seven countries, each involved in some effort at reform, if not transformation, of the mental health system. Utilizing the Institute of Medicine's Quality Chasm Series as an organizing framework, problems, visions, priorities, and strategies from Australia, Canada, England, Italy, New Zealand, Scotland, and the United States are reviewed and compared. One of the most important themes related to reform efforts includes the emergence of the recovery paradigm as the basis for the development of new mental health policies and the system of care. This theme as well as other issues and solutions that show great congruence across countries' reform agendas have a relevant impact on mental health workforce policies. The implications of these efforts for leadership and development of the global mental health workforce are considered along with opportunities for shared learning and collaboration.     

Characteristics of Violent Versus Nonviolent Patients with Schizophrenia

Recent research has demonstrated an associative link between some forms of mental illness and violence. While much of this violence is committed by persons with schizophrenia, the characteristics of violent versus nonviolent schizophrenic patients has received limited attention. Two studies with small sample sizes compared these groups on psychological dimensions in acute care settings, but there appears to be no study of continuing care inpatients. This study compared a statewide sample of violent and nonviolent inpatients with schizophrenia on several domains of social interpersonal behavior. In a between-group analysis, violent patients showed evidence of serious dysfunction in community self-care and community adjustment, whereas the nonviolent were more impaired in the areas of depression, restlessness, and internal confusion. A within-group analysis of patients with interpersonal violence and those with noninterpersonal violence yielded similar findings of serious community dysfunction versus internal confusion. The implications are discussed.     

Management of Demented Patients with Urinary Incontinence: A Case Study

Objective: To assess whether a demented patient with urinary incontinence (UI) could learn to use an adapted version of timed voiding (i.e., instead of being led by a caregiver, the patient learns to perform timed voiding by herself). Indeed, UI affects a large number of patients with dementia and creates a substantial burden to the caregiver. UI is the most common complaint at the time of institutionalization and it is often the cause of premature institutionalization. Timed voiding is a promising intervention, but one whose effectiveness remains to be demonstrated. Additionally, timed voiding has the disadvantage of being constraining for caregivers, requiring them to be present to stimulate the patient to urinate at each of the scheduled occasions. Method: The present intervention required the patient to learn (1) to associate an auditory signal from a timer to the action of urination, (2) to reprogram the timer, using the spaced retrieval technique. An ABAB paradigm was used to assess the effectiveness of this program to eliminate urinary accidents. Results: The results of the intervention showed that the use of the timer was effective in helping the patient to reduce her urinary leaks from 1.5 diurnal accidents per week to zero during four months. Conclusion: UI in patients with dementia seems treatable. Such intervention could contribute to delay institutionalization of patients with dementia through maintaining their autonomy and reducing the burden of caregivers.